scholarly journals Quality conceptualization in the era of measurement: A qualitative study of primary care physicians in Medicare’s Merit-Based Incentive Payment System

2020 ◽  
Author(s):  
Carl Thomas Berdahl ◽  
Molly C Easterlin ◽  
Gery Ryan ◽  
Jack Needleman ◽  
Teryl K Nuckols
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Pay For Performance ◽  
Patient Centered Care ◽  
Payment System ◽  
Incentive Payment ◽  
Patient Centered ◽  
Centered Care ◽  
Quality In Healthcare

Abstract Background: While governmental programs seeking to improve the quality and value of healthcare through pay-for-performance initiatives have good intentions, participating physicians may be reluctant to participate for various reasons, including poor program alignment with considerations relevant to daily clinical practice. In this study, we sought to characterize how primary care physicians (PCPs) participating in Medicare’s Merit-Based Incentive Payment System (MIPS) conceptualize the quality of healthcare to help inform future measurement strategies that physicians would understand and appreciate.Methods: We performed semi-structured qualitative interviews with a nationwide sample of 20 PCPs participating in MIPS who were trained in internal medicine or family medicine. We asked PCPs how they would characterize quality in healthcare and what distinguished exceptional, good, and poor quality from one another. Interviews were transcribed and two coders independently read transcripts, allowing data to emerge from the interviews and developing theories about the data. The coders met intermittently to discuss findings, harmonize the coding scheme, develop a final list of themes and sub-themes, and aggregate a list of representative quotations.Results: Participants described quality in healthcare as consisting of two components: (1) evidence-based care that is safe, which included appropriate health maintenance and chronic disease control, accurate diagnoses, and adherence to guidelines and (2) patient-centered care, which included spending enough time with patients, responding to patient concerns, and establishing long-term patient-physician relationships that were founded upon trust. Conclusions: PCPs consider patient-centered care to be necessary for the provision of exceptional quality in healthcare. Program administrators for quality measurement and pay-for-performance programs should explore new ways to reward PCPs for providing outstanding patient-centered care. Future research should be undertaken to determine whether patient-centered activities such as forging long-term, favorable patient-physician relationships, are associated with improved health outcomes.

scholarly journals What Do Clinicians Who Deliver Maternity Services Think Patient-Centered Care Is and How Is That Different for Vulnerable Women? A Qualitative Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Ted Adams ◽  
Dana Sarnak ◽  
Joy Lewis ◽  
Jeff Convissar ◽  
Scott S. Young
Keyword(s):  
Qualitative Study ◽  
Primary Care Physicians ◽  
Health Management ◽  
Physician Assistants ◽  
Patient Centered Care ◽  
Fee For Service ◽  
Institute Of Medicine ◽  
Patient Centered ◽  
Maternity Services ◽  
Centered Care

Background. Patient-centered care is said to have a myriad of benefits; however, there is a lack of agreement on what exactly it consists of and how clinicians should deliver it for the benefit of their patients. In the context of maternity services and in particular for vulnerable women, we explored how clinicians describe patient-centered care and how the concept is understood in their practice. Methods. We undertook a qualitative study using interviews and a focus group, based on an interview guide developed from various patient surveys focused around the following questions: (i) How do clinicians describe patient-centered care? (ii) How does being patient-centered affect how care is delivered? (iii) Is this different for vulnerable populations? And if so, how? We sampled obstetricians and gynecologists, midwives, primary care physicians, and physician assistants from a health management organization and fee for service clinician providers from two states in the US covering insured and Medicaid populations. Results. Building a relationship between clinician and patient is central to what clinicians believe patient-centered care is. Providing individually appropriate care, engaging family members, transferring information from clinician to patient and from patient to clinician, and actively engaging with patients are also key concepts. However, vulnerable women did not benefit from patient-centered care without first having some of their nonmedical needs met by their clinician. Discussion. Most providers did not cite the core concepts of patient-centered care as defined by the Institute of Medicine and others.

scholarly journals Soldier-Centered Care: A Concept Analysis

2020 ◽  
Vol 185 (3-4) ◽  
pp. e422-e430
Author(s):  
Tanekkia M Taylor-Clark ◽  
Patricia A Patrician
Keyword(s):  
Primary Care ◽  
Physical Performance ◽  
Patient Centered Care ◽  
Concept Analysis ◽  
Medical Department ◽  
Patient Centered ◽  
Medical Needs ◽  
Leadership Support ◽  
Centered Care ◽  
The U.S

Abstract Introduction It is critical for the U.S. Army Medical Department to acknowledge the distinctive medical needs of soldiers and conceptualize soldier-centered care as a unique concept. In addition to the nationally recognized standards of patient-centered care, soldier-centered care includes provisions for the priorities of soldier health and wellness, injury prevention, illness and injury management, and the preservation of physical performance and medical readiness. The development of soldier-centered care as a distinctive concept may strengthen the evidence base for interventions that support improvements to soldier care and thus, enhance health outcomes specific to soldiers. The purpose of this article is to analyze the concept of soldier-centered care, clarify the meaning of soldier-centered care, and propose a theoretical definition. Methods Rodgers’ evolutionary concept analysis method was used to search and analyze the literature for related terms, attributes, antecedents, and consequences and to create a theoretical definition for soldier-centered care. Results The results of this concept analysis indicated that soldier-centered care is realized through the presence of nine attributes: operational alignment of care, provider and support staff therapeutic competence, management of transitions and care coordination, technology and accessibility, management of limited and lost work days, trust and expectation management, leadership support, continuity, and access to care. Soldier-centered care is focused on health and wellness promotion, disease and injury prevention, and early diagnosis and treatment of acute injuries in the primary care setting to facilitate timely injury recovery, reduce reinjury, and prevent long-term disabilities. The result of soldier-centered care is enhanced physical performance, medical readiness, and deployability for soldiers. Based on the literature analysis, the following theoretical definition of soldier-centered care is proposed: Soldier-centered care is individualized, comprehensive healthcare tailored to the soldier’s unique medical needs delivered by a care team of competent primary care providers and support staff who prioritize trust and expectation management, operational alignment of care, leadership support, care coordination, and the management of limited and lost workdays through the use of evidence-based practice approaches that employ innovative information technology to balance access to care and continuity. Conclusions The concept of soldier-centered care often emerges in discussions about optimal physical performance and medical readiness for soldiers. Although soldier-centered care and patient-centered care have similar conceptual underpinning, it is important to clarify the unique physical and medical requirements for soldiers that differentiate soldier-centered care from patient-centered care. Implementing the defining attributes of soldier-centered care in the U.S. Army primary care setting may improve the quality of care and health outcomes for soldiers. When defining performance metrics for primary care models of care, the U.S. Army Medical Department must consider assessing outcomes specific to the soldier population. Developing empirical indicators for the attributes of soldier-centered care will support meaningful testing of the concept.

Patient-centered care and communication in primary care practice: what is involved?

2005 ◽  
Vol 58 (3) ◽  
pp. 296-304 ◽  
Author(s):  
Virginia Aita ◽  
Helen McIlvain ◽  
Elisabeth Backer ◽  
Kristine McVea ◽  
Benjamin Crabtree
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Patient Centered Care ◽  
Care Practice ◽  
Patient Centered ◽  
Centered Care

scholarly journals Relationship Between Adolescent Report of Patient-Centered Care and of Quality of Primary Care

2016 ◽  
Vol 16 (8) ◽  
pp. 770-776 ◽  
Author(s):  
Sara L. Toomey ◽  
Marc N. Elliott ◽  
David C. Schwebel ◽  
Susan R. Tortolero ◽  
Paula M. Cuccaro ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Adolescent Report ◽  
Quality Of Primary Care ◽  
Centered Care
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